Provider Demographics
NPI:1033155171
Name:TRAINOR, JACK MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MARSHALL
Last Name:TRAINOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2829 NE 33RD CT
Mailing Address - Street 2:#405
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-2028
Mailing Address - Country:US
Mailing Address - Phone:954-564-5725
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:SUITE A-39
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-771-8177
Practice Address - Fax:954-771-3629
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77382207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME77382OtherMEDICAL LICENSE
FLME77382OtherMEDICAL LICENSE